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General NPI Number Information
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NPI Number | 1801945423
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Entity Type | Organization
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Legal Business Name | BIOFEEDBACK & PSYCHOTHERAPY DEVELOPMENT LCSW HEALTH SERVICES PC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 5 SUNRISE PLAZA SUITE #202
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City | VALLEY STREAM
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State | NY
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Zip | 11580-6130
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Country | US
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Telephone | 516-825-5005
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Fax | 516-825-5778
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Provider Business Mailing Address
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Address Line | 5 SUNRISE PLAZA SUITE #202
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City | VALLEY STREAM
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State | NY
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Zip | 11580-6130
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Country | US
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Telephone | 516-825-5005
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Fax | 516-825-5778
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARC A ZIMMER
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Credential | PHD
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Telephone | 516-825-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NY
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